Post operative nausea and vomiting (PONV) remains a significant problem especially in the ambulatory surgery setting where delayed discharge from PACU or unanticipated admission to hospital can result. Nausea and Vomiting in the post operative period is among the top reasons for patient dissatisfaction with their post operative care. The incidence despite new antiemetics remians 20 to 30 %. Protracted difficulties interfere with pain management and participation in physical therapy.